Healthcare Provider Details

I. General information

NPI: 1538433701
Provider Name (Legal Business Name): KRYSTALEE KREY MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 11/23/2025
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 VIA CTR STE B
VISTA CA
92081-6056
US

IV. Provider business mailing address

6399 SAN IGNACIO AVE STE 120
SAN JOSE CA
95119-1215
US

V. Phone/Fax

Practice location:
  • Phone: 760-295-2299
  • Fax: 760-216-5300
Mailing address:
  • Phone: 408-369-5620
  • Fax: 408-904-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA54872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: